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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-4959

2. Registrant Information.

Registrant Reference Number: 1825984

Registrant Name (Full Legal Name no abbreviations): Bell Laboratories, Inc.

Address: 3699 Kinsman Blvd

City: Madison

Prov / State: WI

Country: USA

Postal Code: 53704

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

20-MAY-16

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

19-MAY-16

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Bromethalin (non-specific)

  • Active Ingredient(s)
    • BROMETHALIN
      • Guarantee/concentration .01 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

German Shorthaired Pointer

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.03

7. Weight (provide a range if necessary )

1.7

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Foaming at mouth
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Trembling

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Nursing from a dog which had a speculated ingestion.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

5/20/2016 2:44:38 PM A veterinarian called with questions about his own dog. His 2 year old dog is nursing 8, 11 day old puppies, 3 of which recently developed twitching and one additional puppy which died. He thinks the nursing dog may have ingested one block of unknown size. He did not have the package with him but stated the product came in a pail and recalled the blocks to be approximately appeared to be 1x1x1.5 inches. He placed one block under a shop table in his shed and now can't find it. He saw his nursing dog trying to dig under the table this morning and stopped her. Therefore, he thinks she was going back to that spot because she previously found the block there. To be cautious, he induced vomiting this morning in case she had ingested the block but the vomitus was clear (no evidence of rodenticide). No indicator dye has been noticed in the feces over the past few days. The nursing mother is asymptomatic. One puppy died this morning, approximately 6 hours after it developed tremoring and foaming at the mouth last night. He worries that the other puppies are twitching more than normal for their age (some twitching is normal at this age). He plans to pull the pups off now and will bottle feed or put on a different nursing dog.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

German Shorthaired Pointer

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

0.03

7. Weight (provide a range if necessary )

1.7

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Muscle twitching
    • Specify - Twitching

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Nursing from a mother dog with speculated ingestion.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

5/20/2016 2:44:38 PM A veterinarian called with questions about his own dog. His 2 year old dog is nursing 8, 11 day old puppies, 3 of which recently developed twitching and one additional puppy which died. He thinks the nursing dog may have ingested one block of unknown size. He did not have the package with him but stated the product came in a pail and recalled the blocks to be approximately appeared to be 1x1x1.5 inches. He placed one block under a shop table in his shed and now can't find it. He saw his nursing dog trying to dig under the table this morning and stopped her. Therefore, he thinks she was going back to that spot because she previously found the block there. To be cautious, he induced vomiting this morning in case she had ingested the block but the vomitus was clear (no evidence of rodenticide). No indicator dye has been noticed in the feces over the past few days. The nursing mother is asymptomatic. One puppy died this morning, approximately 6 hours after it developed tremoring and foaming at the mouth last night. He worries that the other puppies are twitching more than normal for their age (some twitching is normal at this age). He plans to pull the pups off now and will bottle feed or put on a different nursing dog.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.